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Insurance Fraud Detection Global Market Insights 2025, Analysis and Forecast to 2030, by Market Participants, Regions, Technology, Application, Product Type

Publisher Prof-Research
Published Nov 22, 2025
Length 87 Pages
SKU # PROF20605600

Description

Insurance Fraud Detection Market Summary

Insurance Fraud Detection refers to AI-powered analytics and monitoring systems that identify, investigate, and prevent fraudulent claims, applications, and policy abuses in real-time by analyzing behavioral patterns, anomaly signals, and network relationships across structured claims data, unstructured documents, and external sources like social media and credit bureaus. These platforms employ machine learning models for unsupervised clustering, graph analytics for collusion rings, and natural language processing for document forgery detection, achieving 80–95% accuracy in flagging high-risk cases while reducing false positives by 40–60% through continuous learning. Unlike manual audits or rule-based screening, insurance fraud detection operates as an autonomous risk engine, integrating with core systems for automated investigations, alerting investigators with prioritized leads, and enabling predictive prevention via behavioral biometrics and geofencing. Powered by generative AI for synthetic fraud scenario simulation, federated learning for privacy-preserving data sharing across insurers, and blockchain for immutable claim histories, modern solutions process billions of transactions annually with sub-second latency and ROI exceeding 5:1 in recovered funds. The global Insurance Fraud Detection market is expected to reach between USD 3.0 billion and USD 8.0 billion by 2025. Despite being a vigilant niche within the $6 trillion+ insurance industry, fraud detection serves an indispensable role as the sentinel against $80–100 billion in annual global losses. Between 2025 and 2030, the market is projected to grow at a compound annual growth rate (CAGR) of approximately 15.0% to 25.0%, driven by the insurtech revolution, regulatory mandates for AI transparency, and the escalation of sophisticated cyber-fraud. This explosive growth underscores the technology's transformative power in reclaiming integrity from deception, even as the sector grapples with ethical AI and data governance imperatives.

Industry Characteristics

Insurance Fraud Detection belongs to the family of predictive risk analytics, which are typically deployed as embedded layers within claims processing engines and underwriting workflows to dissect transactional anomalies into prosecutable evidence. While traditional rule engines trigger alerts on thresholds, modern detection decomposes behavioral signals into probabilistic risk scores through ensemble models and graph neural networks. This synergistic mechanism allows for enhanced protection against first-party padding, third-party mills, and application fraud, particularly in high-velocity digital channels.

The industry is characterized by high specialization, with development concentrated among a limited number of analytics powerhouses and insurtech disruptors. These innovators are often integrated within the broader insurtech market, supplying detection modules for P&C, health, and life lines. Compared with general cybersecurity or BI tools, the insurance fraud detection market is more domain-specific, but its critical role in recovering 10–15% of premiums lost to fraud ensures robust demand.

Insurance Fraud Detection is particularly valued in property and casualty claims. Auto and property lines, which account for the largest share of fraud incidents, are prone to staged accidents and exaggeration, and the incorporation of AI models significantly refines adjudication, particularly under volume surges. Rising demand for P&C in telematics-era policies ensures continued reliance on detection as part of claims systems.

Regional Market Trends

The consumption of Insurance Fraud Detection is distributed across all major regions, with demand closely linked to insurance penetration and digital claims volumes.

North America: The North American market is estimated to hold a moderate share of global Insurance Fraud Detection consumption. Growth in this region is projected in the range of 15.0%–22.0% through 2030. The demand is supported by mature but steady P&C markets in the United States, especially for auto telematics and health claims. Insurers, which rely on detection for loss ratio control, also contribute to steady demand. Regulatory pressures regarding fair claims practices have prompted local carriers to optimize AI models, which continues to sustain usage as part of standard adjudication protocols.

Europe: Europe represents another important market, with estimated growth in the 14.0%–21.0% range over the forecast period. The European insurance sector is advanced, with strict regulatory frameworks regarding data protection. Demand for Insurance Fraud Detection is supported by the P&C, health, and life sectors. However, environmental regulations and a strong push toward ethical AI pose both challenges and opportunities for detection providers. The incorporation of fraud tools in GDPR-compliant claims is becoming increasingly important, which is likely to sustain demand in this region.

Asia-Pacific (APAC): APAC is the dominant region for Insurance Fraud Detection consumption, expected to grow at 16.0%–25.0% CAGR through 2030. China, India, Japan, and South Korea drive the majority of demand due to their large-scale digital insurance platforms, health digitization, and auto markets. In particular, China accounts for the largest share, supported by its massive WeBank and Ping An ecosystems. India is experiencing rapid growth in micro-insurance fraud prevention for rural claims, further boosting consumption. APAC’s leadership is also supported by the presence of several key analytics providers and cost-competitive insurtech talent.

Latin America: The Latin American market remains relatively small but is projected to grow in the range of 15.0%–22.0%. Brazil and Mexico are the primary countries driving demand, supported by expanding digital P&C and health insurance. Economic volatility in some Latin American countries may limit broader market expansion, but steady demand for fraud control ensures a consistent role for detection in claims systems.

Middle East and Africa (MEA): MEA is an emerging market, with estimated growth in the 15.5%–23.0% range. The region benefits from investments in digital insurance and health tech, particularly in the Gulf countries. As regional claims volumes grow, consumption of detection for organized fraud rings is expected to increase correspondingly.

Application Analysis

Insurance Fraud Detection applications are concentrated in Small and Medium-Sized Enterprises (SMEs) and Large Enterprises, across Solutions and Services components, each demonstrating unique growth dynamics and functional roles.

Large Enterprises: This is the largest application segment, accounting for the majority of Insurance Fraud Detection consumption. Growth in this application is estimated in the range of 15.5%–24.0% CAGR through 2030. Large insurers are prone to high-volume claims fraud, and the incorporation of detection significantly enhances recovery, particularly under complex P&C portfolios. Rising demand for large enterprises in global operations ensures continued reliance on detection as part of enterprise systems.

Small and Medium-Sized Enterprises: Growth in this segment is projected in the 14.5%–22.0% range, supported by affordable SaaS models. SMEs rely on detection to protect against small-scale abuse. Trends include plug-and-play integrations and mobile-first alerts.

Company Landscape

The Insurance Fraud Detection market is served by a mix of analytics giants and insurtech specialists, many of which operate across the broader risk intelligence ecosystem.

IBM Corporation: IBM's Watson Fraud Detection leverages cognitive AI for claims pattern recognition, supplying large insurers with scalable, explainable models.

SAS Institute Inc.: SAS's Fraud Framework excels in graph analytics for collusion detection, dominant in P&C carriers.

Fair Isaac Corporation (FICO): FICO's Falcon platform provides real-time scoring, strong in credit and health fraud.

Experian plc: Experian's Ascend Analytics integrates external data for application fraud, favored by SMEs.

LexisNexis Risk Solutions: LexisNexis's Bridger Insight XG focuses on identity verification, widely used in global operations.

Industry Value Chain Analysis

The value chain of Insurance Fraud Detection spans data ingestion to fraud prosecution. Upstream, claims systems stream transactions via APIs, with external sources enriching via partnerships. Detection engines apply ML ensembles for scoring, integrating with SIEM for alerts. Investigators triage via dashboards, triggering automated workflows. Downstream, recoveries feed actuarial models. The chain highlights detection as a specialty sentinel, enhancing high-volume claims performance with predictive acuity.

Opportunities and Challenges

The Insurance Fraud Detection market presents several opportunities:

Digital claims surge: Global insurtech growth directly drives detection demand, particularly in SMEs and large enterprises.

AI ethics mandates: As transparency rises, detection offers a significant growth avenue for explainable models.

Emerging markets: Rapid insurance penetration in Asia-Pacific and Latin America creates new opportunities for mobile-first tools.

However, the industry also faces challenges:

Environmental regulations: Stricter EU data minimization may pressure providers to innovate federated learning.

Market concentration: With a limited number of analytics leaders, the market faces risks related to supply stability and model commoditization.

Competition from blockchain: Immutable ledgers may reduce reliance on traditional detection, requiring providers to adapt to evolving preferences.

Table of Contents

87 Pages
Chapter 1 Executive Summary
Chapter 2 Abbreviation and Acronyms
Chapter 3 Preface
3.1 Research Scope
3.2 Research Sources
3.2.1 Data Sources
3.2.2 Assumptions
3.3 Research Method
Chapter Four Market Landscape
4.1 Market Overview
4.2 Classification/Types
4.3 Application/End Users
Chapter 5 Market Trend Analysis
5.1 Introduction
5.2 Drivers
5.3 Restraints
5.4 Opportunities
5.5 Threats
Chapter 6 Industry Chain Analysis
6.1 Upstream/Suppliers Analysis
6.2 Insurance Fraud Detection Analysis
6.2.1 Technology Analysis
6.2.2 Cost Analysis
6.2.3 Market Channel Analysis
6.3 Downstream Buyers/End Users
Chapter 7 Latest Market Dynamics
7.1 Latest News
7.2 Merger and Acquisition
7.3 Planned/Future Project
7.4 Policy Dynamics
Chapter 8 Historical and Forecast Insurance Fraud Detection Market in North America (2020-2030)
8.1 Insurance Fraud Detection Market Size
8.2 Insurance Fraud Detection Market by End Use
8.3 Competition by Players/Suppliers
8.4 Insurance Fraud Detection Market Size by Type
8.5 Key Countries Analysis
8.5.1 United States
8.5.2 Canada
8.5.3 Mexico
Chapter 9 Historical and Forecast Insurance Fraud Detection Market in South America (2020-2030)
9.1 Insurance Fraud Detection Market Size
9.2 Insurance Fraud Detection Market by End Use
9.3 Competition by Players/Suppliers
9.4 Insurance Fraud Detection Market Size by Type
9.5 Key Countries Analysis
9.5.1 Brazil
9.5.2 Argentina
9.5.3 Chile
9.5.4 Peru
Chapter 10 Historical and Forecast Insurance Fraud Detection Market in Asia & Pacific (2020-2030)
10.1 Insurance Fraud Detection Market Size
10.2 Insurance Fraud Detection Market by End Use
10.3 Competition by Players/Suppliers
10.4 Insurance Fraud Detection Market Size by Type
10.5 Key Countries Analysis
10.5.1 China
10.5.2 India
10.5.3 Japan
10.5.4 South Korea
10.5.5 Southest Asia
10.5.6 Australia
Chapter 11 Historical and Forecast Insurance Fraud Detection Market in Europe (2020-2030)
11.1 Insurance Fraud Detection Market Size
11.2 Insurance Fraud Detection Market by End Use
11.3 Competition by Players/Suppliers
11.4 Insurance Fraud Detection Market Size by Type
11.5 Key Countries Analysis
11.5.1 Germany
11.5.2 France
11.5.3 United Kingdom
11.5.4 Italy
11.5.5 Spain
11.5.6 Belgium
11.5.7 Netherlands
11.5.8 Austria
11.5.9 Poland
11.5.10 Russia
Chapter 12 Historical and Forecast Insurance Fraud Detection Market in MEA (2020-2030)
12.1 Insurance Fraud Detection Market Size
12.2 Insurance Fraud Detection Market by End Use
12.3 Competition by Players/Suppliers
12.4 Insurance Fraud Detection Market Size by Type
12.5 Key Countries Analysis
12.5.1 Egypt
12.5.2 Israel
12.5.3 South Africa
12.5.4 Gulf Cooperation Council Countries
12.5.5 Turkey
Chapter 13 Summary For Global Insurance Fraud Detection Market (2020-2025)
13.1 Insurance Fraud Detection Market Size
13.2 Insurance Fraud Detection Market by End Use
13.3 Competition by Players/Suppliers
13.4 Insurance Fraud Detection Market Size by Type
Chapter 14 Global Insurance Fraud Detection Market Forecast (2025-2030)
14.1 Insurance Fraud Detection Market Size Forecast
14.2 Insurance Fraud Detection Application Forecast
14.3 Competition by Players/Suppliers
14.4 Insurance Fraud Detection Type Forecast
Chapter 15 Analysis of Global Key Vendors
15.1 IBM Corporation
15.1.1 Company Profile
15.1.2 Main Business and Insurance Fraud Detection Information
15.1.3 SWOT Analysis of IBM Corporation
15.1.4 IBM Corporation Insurance Fraud Detection Revenue, Gross Margin and Market Share (2020-2025)
15.2 SAS Institute Inc.
15.2.1 Company Profile
15.2.2 Main Business and Insurance Fraud Detection Information
15.2.3 SWOT Analysis of SAS Institute Inc.
15.2.4 SAS Institute Inc. Insurance Fraud Detection Revenue, Gross Margin and Market Share (2020-2025)
15.3 Fair Isaac Corporation (FICO)
15.3.1 Company Profile
15.3.2 Main Business and Insurance Fraud Detection Information
15.3.3 SWOT Analysis of Fair Isaac Corporation (FICO)
15.3.4 Fair Isaac Corporation (FICO) Insurance Fraud Detection Revenue, Gross Margin and Market Share (2020-2025)
15.4 Experian plc
15.4.1 Company Profile
15.4.2 Main Business and Insurance Fraud Detection Information
15.4.3 SWOT Analysis of Experian plc
15.4.4 Experian plc Insurance Fraud Detection Revenue, Gross Margin and Market Share (2020-2025)
15.5 LexisNexis Risk Solutions
15.5.1 Company Profile
15.5.2 Main Business and Insurance Fraud Detection Information
15.5.3 SWOT Analysis of LexisNexis Risk Solutions
15.5.4 LexisNexis Risk Solutions Insurance Fraud Detection Revenue, Gross Margin and Market Share (2020-2025)
15.6 BAE Systems Inc.
15.6.1 Company Profile
15.6.2 Main Business and Insurance Fraud Detection Information
15.6.3 SWOT Analysis of BAE Systems Inc.
15.6.4 BAE Systems Inc. Insurance Fraud Detection Revenue, Gross Margin and Market Share (2020-2025)
15.7 ACI Worldwide Inc.
15.7.1 Company Profile
15.7.2 Main Business and Insurance Fraud Detection Information
15.7.3 SWOT Analysis of ACI Worldwide Inc.
15.7.4 ACI Worldwide Inc. Insurance Fraud Detection Revenue, Gross Margin and Market Share (2020-2025)
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Tables and Figures
Table Abbreviation and Acronyms
Table Research Scope of Insurance Fraud Detection Report
Table Data Sources of Insurance Fraud Detection Report
Table Major Assumptions of Insurance Fraud Detection Report
Figure Market Size Estimated Method
Figure Major Forecasting Factors
Figure Insurance Fraud Detection Picture
Table Insurance Fraud Detection Classification
Table Insurance Fraud Detection Applications
Table Drivers of Insurance Fraud Detection Market
Table Restraints of Insurance Fraud Detection Market
Table Opportunities of Insurance Fraud Detection Market
Table Threats of Insurance Fraud Detection Market
Table Raw Materials Suppliers
Table Different Production Methods of Insurance Fraud Detection
Table Cost Structure Analysis of Insurance Fraud Detection
Table Key End Users
Table Latest News of Insurance Fraud Detection Market
Table Merger and Acquisition
Table Planned/Future Project of Insurance Fraud Detection Market
Table Policy of Insurance Fraud Detection Market
Table 2020-2030 North America Insurance Fraud Detection Market Size
Figure 2020-2030 North America Insurance Fraud Detection Market Size and CAGR
Table 2020-2030 North America Insurance Fraud Detection Market Size by Application
Table 2020-2025 North America Insurance Fraud Detection Key Players Revenue
Table 2020-2025 North America Insurance Fraud Detection Key Players Market Share
Table 2020-2030 North America Insurance Fraud Detection Market Size by Type
Table 2020-2030 United States Insurance Fraud Detection Market Size
Table 2020-2030 Canada Insurance Fraud Detection Market Size
Table 2020-2030 Mexico Insurance Fraud Detection Market Size
Table 2020-2030 South America Insurance Fraud Detection Market Size
Figure 2020-2030 South America Insurance Fraud Detection Market Size and CAGR
Table 2020-2030 South America Insurance Fraud Detection Market Size by Application
Table 2020-2025 South America Insurance Fraud Detection Key Players Revenue
Table 2020-2025 South America Insurance Fraud Detection Key Players Market Share
Table 2020-2030 South America Insurance Fraud Detection Market Size by Type
Table 2020-2030 Brazil Insurance Fraud Detection Market Size
Table 2020-2030 Argentina Insurance Fraud Detection Market Size
Table 2020-2030 Chile Insurance Fraud Detection Market Size
Table 2020-2030 Peru Insurance Fraud Detection Market Size
Table 2020-2030 Asia & Pacific Insurance Fraud Detection Market Size
Figure 2020-2030 Asia & Pacific Insurance Fraud Detection Market Size and CAGR
Table 2020-2030 Asia & Pacific Insurance Fraud Detection Market Size by Application
Table 2020-2025 Asia & Pacific Insurance Fraud Detection Key Players Revenue
Table 2020-2025 Asia & Pacific Insurance Fraud Detection Key Players Market Share
Table 2020-2030 Asia & Pacific Insurance Fraud Detection Market Size by Type
Table 2020-2030 China Insurance Fraud Detection Market Size
Table 2020-2030 India Insurance Fraud Detection Market Size
Table 2020-2030 Japan Insurance Fraud Detection Market Size
Table 2020-2030 South Korea Insurance Fraud Detection Market Size
Table 2020-2030 Southeast Asia Insurance Fraud Detection Market Size
Table 2020-2030 Australia Insurance Fraud Detection Market Size
Table 2020-2030 Europe Insurance Fraud Detection Market Size
Figure 2020-2030 Europe Insurance Fraud Detection Market Size and CAGR
Table 2020-2030 Europe Insurance Fraud Detection Market Size by Application
Table 2020-2025 Europe Insurance Fraud Detection Key Players Revenue
Table 2020-2025 Europe Insurance Fraud Detection Key Players Market Share
Table 2020-2030 Europe Insurance Fraud Detection Market Size by Type
Table 2020-2030 Germany Insurance Fraud Detection Market Size
Table 2020-2030 France Insurance Fraud Detection Market Size
Table 2020-2030 United Kingdom Insurance Fraud Detection Market Size
Table 2020-2030 Italy Insurance Fraud Detection Market Size
Table 2020-2030 Spain Insurance Fraud Detection Market Size
Table 2020-2030 Belgium Insurance Fraud Detection Market Size
Table 2020-2030 Netherlands Insurance Fraud Detection Market Size
Table 2020-2030 Austria Insurance Fraud Detection Market Size
Table 2020-2030 Poland Insurance Fraud Detection Market Size
Table 2020-2030 Russia Insurance Fraud Detection Market Size
Table 2020-2030 MEA Insurance Fraud Detection Market Size
Figure 2020-2030 MEA Insurance Fraud Detection Market Size and CAGR
Table 2020-2030 MEA Insurance Fraud Detection Market Size by Application
Table 2020-2025 MEA Insurance Fraud Detection Key Players Revenue
Table 2020-2025 MEA Insurance Fraud Detection Key Players Market Share
Table 2020-2030 MEA Insurance Fraud Detection Market Size by Type
Table 2020-2030 Egypt Insurance Fraud Detection Market Size
Table 2020-2030 Israel Insurance Fraud Detection Market Size
Table 2020-2030 South Africa Insurance Fraud Detection Market Size
Table 2020-2030 Gulf Cooperation Council Countries Insurance Fraud Detection Market Size
Table 2020-2030 Turkey Insurance Fraud Detection Market Size
Table 2020-2025 Global Insurance Fraud Detection Market Size by Region
Table 2020-2025 Global Insurance Fraud Detection Market Size Share by Region
Table 2020-2025 Global Insurance Fraud Detection Market Size by Application
Table 2020-2025 Global Insurance Fraud Detection Market Share by Application
Table 2020-2025 Global Insurance Fraud Detection Key Vendors Revenue
Figure 2020-2025 Global Insurance Fraud Detection Market Size and Growth Rate
Table 2020-2025 Global Insurance Fraud Detection Key Vendors Market Share
Table 2020-2025 Global Insurance Fraud Detection Market Size by Type
Table 2020-2025 Global Insurance Fraud Detection Market Share by Type
Table 2025-2030 Global Insurance Fraud Detection Market Size by Region
Table 2025-2030 Global Insurance Fraud Detection Market Size Share by Region
Table 2025-2030 Global Insurance Fraud Detection Market Size by Application
Table 2025-2030 Global Insurance Fraud Detection Market Share by Application
Table 2025-2030 Global Insurance Fraud Detection Key Vendors Revenue
Figure 2025-2030 Global Insurance Fraud Detection Market Size and Growth Rate
Table 2025-2030 Global Insurance Fraud Detection Key Vendors Market Share
Table 2025-2030 Global Insurance Fraud Detection Market Size by Type
Table 2025-2030 Insurance Fraud Detection Global Market Share by Type
Table IBM Corporation Information
Table SWOT Analysis of IBM Corporation
Table 2020-2025 IBM Corporation Insurance Fraud Detection Revenue Gross Profit Margin
Figure 2020-2025 IBM Corporation Insurance Fraud Detection Revenue and Growth Rate
Figure 2020-2025 IBM Corporation Insurance Fraud Detection Market Share
Table SAS Institute Inc. Information
Table SWOT Analysis of SAS Institute Inc.
Table 2020-2025 SAS Institute Inc. Insurance Fraud Detection Revenue Gross Profit Margin
Figure 2020-2025 SAS Institute Inc. Insurance Fraud Detection Revenue and Growth Rate
Figure 2020-2025 SAS Institute Inc. Insurance Fraud Detection Market Share
Table Fair Isaac Corporation (FICO) Information
Table SWOT Analysis of Fair Isaac Corporation (FICO)
Table 2020-2025 Fair Isaac Corporation (FICO) Insurance Fraud Detection Revenue Gross Profit Margin
Figure 2020-2025 Fair Isaac Corporation (FICO) Insurance Fraud Detection Revenue and Growth Rate
Figure 2020-2025 Fair Isaac Corporation (FICO) Insurance Fraud Detection Market Share
Table Experian plc Information
Table SWOT Analysis of Experian plc
Table 2020-2025 Experian plc Insurance Fraud Detection Revenue Gross Profit Margin
Figure 2020-2025 Experian plc Insurance Fraud Detection Revenue and Growth Rate
Figure 2020-2025 Experian plc Insurance Fraud Detection Market Share
Table LexisNexis Risk Solutions Information
Table SWOT Analysis of LexisNexis Risk Solutions
Table 2020-2025 LexisNexis Risk Solutions Insurance Fraud Detection Revenue Gross Profit Margin
Figure 2020-2025 LexisNexis Risk Solutions Insurance Fraud Detection Revenue and Growth Rate
Figure 2020-2025 LexisNexis Risk Solutions Insurance Fraud Detection Market Share
Table BAE Systems Inc. Information
Table SWOT Analysis of BAE Systems Inc.
Table 2020-2025 BAE Systems Inc. Insurance Fraud Detection Revenue Gross Profit Margin
Figure 2020-2025 BAE Systems Inc. Insurance Fraud Detection Revenue and Growth Rate
Figure 2020-2025 BAE Systems Inc. Insurance Fraud Detection Market Share
Table ACI Worldwide Inc. Information
Table SWOT Analysis of ACI Worldwide Inc.
Table 2020-2025 ACI Worldwide Inc. Insurance Fraud Detection Revenue Gross Profit Margin
Figure 2020-2025 ACI Worldwide Inc. Insurance Fraud Detection Revenue and Growth Rate
Figure 2020-2025 ACI Worldwide Inc. Insurance Fraud Detection Market Share
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